New large leaks after 18 months of normal leaks... (w/ chinstrap)

[zonker]

> Your min pressure should be more like 8.4, it's too low for you.

Can you help me understand how you came to that conclusion?

... an excellent explanation...

Oh, man, you make me proud. That's SPOT ON! I do love people that pay attention.

hey, i well remember you giving me hell about seven years ago for failure to understand!

[tisket]

I don't claim to be any sort of expert. But the same thing happened to both my girlfriend and I after each of us had been using cpap for a year or 18 months. We suddenly started getting large leaks. What I eventually figured out with help from people here was that they were mouth leaks. We started taping our mouths shut and the leaks stopped.

A chinstrap will not stop leaks if you are using a nasal mask/nasal pillows. Try this: close your mouth completely, clench your teeth together, and try to blow air out your mouth. You will succeed. That is because having lips and teeth closed (what a chinstrap helps with) will not stop air pressure. What does stop it is having your tongue on the roof of your mouth, sealing the airway. If you position your tongue properly against the roof of your mouth you cannot blow air out.

If your tongue relaxes while you are asleep, the air blasting out your mouth tends to wake you up, maybe only partially, and you instantly put your tongue back where it belongs and go back to sleep. (Sometimes it would wake me up completely and I would feel the air blasting.) At first anyway. After a year or more of using cpap, though, I've found a lot of people learn to sleep through these mouth leaks the same way they sleep through other cpap sensations and discomforts. It can take a long time before you (while asleep or half-awake) put your tongue back in position to seal the airway through your mouth.

Solutions for this that I know of include using a full face mask (the official answer), or mouth taping. We went with mouth taping, which a lot of people do because of this situation, but you may wish to try a full face mask. (I tried several but could not get a good seal around my cheeks, you may have better luck.)

[palerider]

hey, i well remember you giving me hell about seven years ago for failure to understand!

um... it ... worked?

I guess I must have sensed the promise that you held.

[vintage]

Thanks! This is super helpful. When I look at the chart it seems like it bottoms out at 6. The average seems like 8.4. Wouldn't 8.4 be more than necessary? Based on the chart I'd guess that 6 would be more appropriate. I'm a newbie to tweaking this stuff!

look again.

that green pressure line shows you are spending more time above 8.4 than below it.

btw, close on the quote feature, but no cigar.

when you see this message, you'll see two symbols ! and ". choose the second. that will quote me in full AND give me a notification.

continued good luck!

The median pressure is 8.42... I'm struggling to understand why setting my min to 8.4 makes sense if half the time is spent under that. To be clear I'm genuinely struggling to understand that - not being snarky! I'm still building my mental model for how this all hangs together. Is "set your min pressure to your average" a rule of thumb?

Thanks =)

[vintage]

> Your min pressure should be more like 8.4, it's too low for you.

Can you help me understand how you came to that conclusion?

... an excellent explanation...

Oh, man, you make me proud. That's SPOT ON! I do love people that pay attention.

I might add that raising the max pressure would be good too, since 10 is too low. (yeah, as usual I'd say to set it to 20 and forget it).

oh and btw. if you want to get someone's attention when you are replying, use the quote feature. there are a lot of users and a lot of posts. not everyone reads every post for many and sundry reasons.

Yeah, I just stumbled back on your reply.

Curious what your thinking is behind setting max to 20? Thanks!

[vintage]

I don't claim to be any sort of expert. But the same thing happened to both my girlfriend and I after each of us had been using cpap for a year or 18 months. We suddenly started getting large leaks. What I eventually figured out with help from people here was that they were mouth leaks. We started taping our mouths shut and the leaks stopped.

A chinstrap will not stop leaks if you are using a nasal mask/nasal pillows. Try this: close your mouth completely, clench your teeth together, and try to blow air out your mouth. You will succeed. That is because having lips and teeth closed (what a chinstrap helps with) will not stop air pressure. What does stop it is having your tongue on the roof of your mouth, sealing the airway. If you position your tongue properly against the roof of your mouth you cannot blow air out.

If your tongue relaxes while you are asleep, the air blasting out your mouth tends to wake you up, maybe only partially, and you instantly put your tongue back where it belongs and go back to sleep. (Sometimes it would wake me up completely and I would feel the air blasting.) At first anyway. After a year or more of using cpap, though, I've found a lot of people learn to sleep through these mouth leaks the same way they sleep through other cpap sensations and discomforts. It can take a long time before you (while asleep or half-awake) put your tongue back in position to seal the airway through your mouth.

Solutions for this that I know of include using a full face mask (the official answer), or mouth taping. We went with mouth taping, which a lot of people do because of this situation, but you may wish to try a full face mask. (I tried several but could not get a good seal around my cheeks, you may have better luck.)

Thanks. I've tried a full face mask and found is super uncomfortable. Maybe it was the wrong one. I'll try mouth taping tonight though. Didn't love it but maybe that's because I want to mouth breathe!

BTW re: this:

> But the same thing happened to both my girlfriend and I after each of us had been using cpap for a year or 18 months. We suddenly started getting large leaks. What I eventually figured out with help from people here was that they were mouth leaks.

What do you think changed between when you weren't having mouth leaks in the first 12-18 months and when you did? Is that a thing, that people mouth leak after some time using a CPAP?

[palerider]

Curious what your thinking is behind setting max to 20? Thanks!

I always advocate for a max of 20 except in exceptional circumstances, because all you're doing by setting the max lower is potentially preventing your auto machine from doing it's job.

Zonker pointed that out in his explanation, your machine hit it's max pressure, and couldn't go as high as it wanted to in order to normalize your breathing.

The machine won't increase the pressure unless it needs to, so why not remove the restriction, and let the machine do it's job?

[tisket]

BTW re: this:

> But the same thing happened to both my girlfriend and I after each of us had been using cpap for a year or 18 months. We suddenly started getting large leaks. What I eventually figured out with help from people here was that they were mouth leaks.

What do you think changed between when you weren't having mouth leaks in the first 12-18 months and when you did? Is that a thing, that people mouth leak after some time using a CPAP?

I think at first the entire cpap experience is alien and every little thing wakes you up (at least it did me, in the end had to get a Hose Buddy to get the hose out of the bed, I roll around a lot and the hose in the bed would break the pillows seal by tugging on it) but after awhile you get used to it and sleep through things like leaks. So when your tongue relaxes it doesn't instantly wake you up enough to put your tongue back, so you get a mouth leak for awhile, and you sleep through it.

[vintage]

Curious what your thinking is behind setting max to 20? Thanks!

I always advocate for a max of 20 except in exceptional circumstances, because all you're doing by setting the max lower is potentially preventing your auto machine from doing it's job.

Zonker pointed that out in his explanation, your machine hit it's max pressure, and couldn't go as high as it wanted to in order to normalize your breathing.

The machine won't increase the pressure unless it needs to, so why not remove the restriction, and let the machine do it's job?

> The machine won't increase the pressure unless it needs to, so why not remove the restriction, and let the machine do it's job?

Makes a lot of sense! Thanks!

[vintage]

BTW re: this:

> But the same thing happened to both my girlfriend and I after each of us had been using cpap for a year or 18 months. We suddenly started getting large leaks. What I eventually figured out with help from people here was that they were mouth leaks.

What do you think changed between when you weren't having mouth leaks in the first 12-18 months and when you did? Is that a thing, that people mouth leak after some time using a CPAP?

I think at first the entire cpap experience is alien and every little thing wakes you up (at least it did me, in the end had to get a Hose Buddy to get the hose out of the bed, I roll around a lot and the hose in the bed would break the pillows seal by tugging on it) but after awhile you get used to it and sleep through things like leaks. So when your tongue relaxes it doesn't instantly wake you up enough to put your tongue back, so you get a mouth leak for awhile, and you sleep through it.

Interesting theory that makes a lot of sense. Appreciate you sharing your insights here.

Think I'm going to crank the min up to 7, crank the max up to 20, and try some mouth taping tonight. Bonus is that I can ditch the chinstrap.

Appreciate everybody's support and ideas here - thank you palerider, zonker, and tisket.

[lynninnj]

> Your min pressure should be more like 8.4, it's too low for you.

Can you help me understand how you came to that conclusion?

i'll take a crack at it and palerider can correct any of my errors.

see the chart that is labeled "pressure"? it has a green line those goes up and down, up and down and so forth. this chart has numbers on the left hand side. this tells you what pressure the machine putting out for each minute that you have the mask on.

the pressure starts at 5, of course, because that's what the machine is set to start at. but then, the pressure slowly goes up as it begins to react to the events happening while you sleep. it rises to 9, then falls back. it ten raises again until in reaches 10. it can't go any further than that because the machine is capped at a maximum of 10.

and so it goes throughout your sleep, up and down. BUT it never goes back to 5. the lowest it gets is just under 7. if you set the minimum at the recommended 8.4, your machine will have a better chance at doing it's job in reacting to the events.

is that clear?

oh and btw. if you want to get someone's attention when you are replying, use the quote feature. there are a lot of users and a lot of posts. not everyone reads every post for many and sundry reasons.

good luck!

Great explainer zonker.

I could have really used the direct answer and tutorial over the rash of nasty crap I got when I asked on a diff thread.

Thanks for taking the time to courteously reply. I am not the OP but I am sure there are other newbies like me looking to learn where to figure out the sweet spot and what DATA POINTS help one make that determination.

In a world where you can be anything be kind.

Thanks.

[zonker]

Interesting theory that makes a lot of sense. Appreciate you sharing your insights here.

Think I'm going to crank the min up to 7, crank the max up to 20, and try some mouth taping tonight. Bonus is that I can ditch the chinstrap.

Appreciate everybody's support and ideas here - thank you palerider, zonker, and tisket.

that will work just fine. i believe in baby steps. this is one of the very few things pr and i disagree on. (shhh! don't tell him.) i believe that palerider hasn't had a moment of aerophagia in his life. and that's a fair kop. me? i get immense amounts of gas if i try to make too big a jump in pressure at one time.

so take it easy. see if it works for you.

just one note of caution-please make ONE change at a time and stick with it over the course of several nights. out minds want this change instantly. our bodies however, not so much. it may take time to see a difference and feel a difference.

continued good luck!

[palerider]

Think I'm going to crank the min up to 7,

You'd do better with at least 8.

[vintage]

Interesting theory that makes a lot of sense. Appreciate you sharing your insights here.

Think I'm going to crank the min up to 7, crank the max up to 20, and try some mouth taping tonight. Bonus is that I can ditch the chinstrap.

Appreciate everybody's support and ideas here - thank you palerider, zonker, and tisket.

that will work just fine. i believe in baby steps. this is one of the very few things pr and i disagree on. (shhh! don't tell him.) i believe that palerider hasn't had a moment of aerophagia in his life. and that's a fair kop. me? i get immense amounts of gas if i try to make too big a jump in pressure at one time.

so take it easy. see if it works for you.

just one note of caution-please make ONE change at a time and stick with it over the course of several nights. out minds want this change instantly. our bodies however, not so much. it may take time to see a difference and feel a difference.

continued good luck!

Ha. As I was making the changes last night the voice in my head was screaming "scientific method! change one variable, not three!"

I ignored the voice in my head.

Changed min to 7 and felt uncomfortable. Bumped it down to 6 during the night and things settled down.

Changed max to 14, mostly because 20 seemed like a big jump. I can bump this up as I get more data.

Also mouth taped which was a bit of a disaster. Ended up using three Somnifix strips over the course of the night as the first two came loose (guessing I didn't apply them correctly). I also put on the chinstrap in the middle of the night between strips 2 and 3 and DID feel air escaping which means I was mouth breathing.

The data is a mess:



Anecdotally, I woke up at 920am after sleeping through 30 minutes of my alarm (I never sleep through my alarm). I didn't feel exhausted, but I didn't feel great. My Oura ring says i only had 30 mins of deep sleep (6% of time in bed, usually this is 15%).

Think I'm going to pick up some 3m micropore tape and see how that goes tonight.

[Pugsy]

Changed max to 14, mostly because 20 seemed like a big jump. I can bump this up as I get more data.

People don't seem to understand that just because a machine CAN go to whatever the max is set to that it changes nothing if the machine NEVER goes near that max. The max is just there in case something special ever happens that might cause the machine to WANT to go higher for some reason or other. Setting a lower max doesn't change the machine's response when in auto adjusting mode. All it might do (when set too low) is prevent the machine from trying to go higher when it thinks it needs to go higher to hold the airway open.

As I was making the changes last night the voice in my head was screaming "scientific method! change one variable, not three!"

I ignored the voice in my head.

There is a very valid reason that in Science 101 they advise one change at a time because if you make more than one change you don't know which change did what.

The reason we want to try taping the mouth first when attempting to isolate the cause of large leaks is to eliminate the chance of mouth breathing leaks. If the tape stays secure through the night (yours didn't) and we still see big leaks then we know that the leak isn't from the mouth opening and have to look at mask movement.
To fix a problem we first have to identify the problem. Obviously the fix for a mouth leak is going to be different from a mask movement leak.

Pick a pressure to use that is comfortable for you both in terms of mentally and physically....gotta get the sleep first for anything to really matter. Then keep that pressure and don't go changing it willy nilly.

You do need more minimum but it is allowable to increase the minimum in small baby steps so that you can more easily get adjusted to the newer pressure. You can also maybe extend the ramp time in hopes of being asleep when the ramp ends and you are at full pressure....or even use the Auto ramp feature instead of regular ramp.